Four patients with severe drug resistant chronic schizophrenia all committed a dangerous act around the time of their discharge from hospital. Discharge from a long stay ward may be an important life event and might therefore be expected to be associated with some depression. Detection of depression among vulnerable schizophrenics may be important if suicide or other dangers are to be prevented.

The relation of childhood separation experiences to adult depression, anxiety and ‘general psychological morbidity’ was assessed in a random population survey. Four causes of separation were examined in each of three age groups: childhood illness, parental illness, parental marital discord and wartime evacuation. Childhood separations occurring up to five years of age bore no relation to depression, anxiety nor to incidence of morbidity generally. From five to ten years of age, separations caused by parental illness and marital discord were related to morbidity, and in the latter instance were more likely to cause depression than anxiety. From 11 to 15 years, only separations due to parental illness were related to morbidity generally.

Seventeen patients were seen by a neurologist for diagnosis of temper tantrums. The referring psychiatrist had thought that they might have been caused by organic disease, either epilepsy or the episodic dyscontrol syndrome. The final diagnosis in every case was temper tantrums due to psychological causes. The patients had a wide range of psychiatric disorders. Theories that might explain the tantrums are discussed.

Follow-up of a large number of long-stay in-patients who were discharged because of local policy showed a high rate of readmission but also much subsequent re-discharge and low overall dependence on inpatient services. There was a high uptake of other forms of support, especially day care; and little evidence of further movement by the patients towards independence. The rate of mortality for the discharged patients was similar to that for the general population.

In a comparison of assessment methods of severity of depressive illness, the Montgomery-åsberg Scale had, broadly, a performance equal to the Hamilton Scale. The Beck Depression Inventory, its subscale, and the Wakefield Inventory all had overall poor performances and should now be abandoned in research. The two-patient-rated scales were, overall, similar and fairly satisfactory measures. The comparisons were at points in severity of illness and not on change of severity.

CSF and plasma GABA was measured in patients with bipolar affective illness and matched controls. There was no correlation between CSF and plasma GABA in 10 pairs of simultaneously obtained samples. Plasma GABA was significantly lower in a group of 10 euthymic medication-free bipolar patients compared to 41 normal volunteers (P <.02). This finding was replicated in a second study involving 6 patients and 10 normal volunteers. Twin studies showed a high correlation between members of 11 monozygotic twin pairs (P <.008). Diurnal variation was minimal, but bimonthly sampling over one year revealed somewhat higher values in the late summer compared to late winter.

Hospital statistics for episodes coded as ‘adverse effects of medicinal agents' were used to study deliberate self-poisoning among people aged 12–20 years in the Oxford Region. Admission rates rose sharply from the age of 12 years, more so for females than males, up to the age of 16 years in females and 18 years in males. Analgesics, antipyretics and psychotropic drugs were the agents most commonly used by both sexes and accounted for three-quarters of all admissions. Admission rates varied from year to year, but increased overall between 1974 and 1979, notably among people under 16 years of age. Admissions for ‘adverse effects of medicinal agents' accounted for 4.7 per cent of all general hospital admissions among people aged 12–20 years.

Eleven drug free patients meeting Research Diagnostic Criteria for Major Depressive Disorder have been treated with desipramine and given a clonidine infusion after 0, 1 and 3 weeks of treatment. The sedative and hypotensive effects of clonidine were significantly inhibited after three weeks of treatment with desipramine: a similar interaction was seen after one week of treatment although this just failed to reach statistical significance. The growth hormone (GH) response to clonidine was initially impaired, but increased significantly after one week of treatment. A significant reduction in the GH response occurred during the second and third weeks of treatment with desipramine. This last finding is interpreted as evidence of adaptive change of α2 adrenoceptors: the other changes can be explained by the known ability of desipramine to block the re-uptake of noradrenaline.

Socio-economic differences between schizophrenics on an acute in-patient unit and their parents were studied in relation to indices of dangerousness and of psychiatric status, It was found that, whatever their class of origin, a large proportion of patients had dropped in occupational attainment, relative to that of their parents, but that patients tended to be higher in education than their parents. Patients who had committed an assaultive act prior to admission were lower in social status than their parents.

Contacts of patients with a large urban day hospital over a decade were analysed in respect of the long-stay population, its patterns of contact and rate of discharge. Two-thirds had been attending continuously for 2–17 years, and a third for 1–2 years; 60 per cent of the latter were readmissions. The majority were admitted more than once and there was great variation in their pattern of contact. The population's growth over the decade was due to a slow average admission rate of 1–2 long-stay patients per fortnight, and an even slower rate of discharge. More men than women attended, especially in the age range 25–44; at the end of the decade the number of long-stay men was still increasing.

The effect of abrupt discontinuation of amitriptyline, desipramine, or imipramine) on norepinephrine turnover and specific symptoms in seven depressed patients was examined. Turnover, as determined by plasma and urinary 3 methoxy-4-hydroxy-phenylethylene glycol (MHPG), was increased to a peak during the second week following discontinuation. There were no changes in blood pressure or heart rate. Two of the seven patients experienced clear increases in anxiety. The implications for the role of noradrenergic function is discussed.

A matched controlled study of 30 chronic schizophrenic suicides is presented. Eighty per cent were male and committed suicide at a mean age of 25.8 years after a mean duration of illness of 4.8 years. Significantly more of the suicides had a chronic relapsing schizophrenic illness; 23.3 per cent committed suicide while in-patients, and 50 per cent of the out-patients committed suicide within three months of discharge from in-patient care. Significantly more of the suicides had a past history of depression (56.6 per cent), were depressed in the last episode of contact (53.3 per cent), had their last admission for depression or suicidal ideation (55.2 per cent) and were unemployed (80 per cent).

Forty-eight undrugged hospital admissions with a present state examination (PSE) diagnosis of schizophrenia were subdivided by the direction of lateral differences in electrodermal response amplitudes to tones. The 29 with larger right-hand responses and the 19 with larger left-hand responses were compared on CATEGO syndromes and brief psychiatric rating scale (BPRS). The larger group had symptoms like those of classical Bleulerian schizophrenia—blunted affect emotional withdrawal, impaired social functioning, disorganized thought and retarded motility. The other group manifested florid symptoms including hypomanic affect pressure of speech, ideas of reference, depressive hallucinations and delusions, hypochondriasis, grandiosity and situational anxiety. The psychophysiological measures may provide an objective aid to diagnosis and implications for altered cerebral organization in psychotic patients.

Psychiatric manifestations were studied in 72 amputees in the post-operative period. All were right handed. Besides phantom limb phenomena, which were observed in nearly four-fifths of the cases and are described in another paper, nearly two-thirds had psychiatric symptoms in the form of depression (45 patients), anxiety (38), crying spells (38), insomnia (34), loss of appetite (23), suicidal ideas (21) and psychotic behaviour (2). Right arm amputees had phantom phenomena and insomnia significantly more often than left.

Nearly one-fifth of the cases were diagnosed as having psychotic depressive reactions, two-fifths as having depressive neurosis and two, both with right upper limb amputations, as schizophrenic.

Between one third and one half of schizophrenic patients appear to benefit from treatment with lithium carbonate. An even higher proportion of schizo-affective patients benefit some showing complete recovery. Current unfavourable views on the use of lithium in schizophrenia are contested. Lithium as well as neuroleptics have a place in the treatment of schizophrenia.

A comparison has been made of costs within in-patient units in a large Scottish psychiatric hospital. Cost differences were found between short-stay, rehabilitation and long-stay psychosis units and beds for the elderly with mental disorder. These differences reflected staffing levels, particularly of nurses. The costs were greater than average for psychiatric hospitals and approximated to geriatric units—a finding in keeping with the high occupancy of beds by the elderly. Existing long-stay elderly patients require to be considered separately in distinguishing elderly in-patient costs without total psychogeriatric care offered by society.

One hundred and seventy-two successive admissions to a district general hospital psychiatric unit were examined. Routine psychiatric, drug and dietary histories were taken and signs of avitaminosis B specifically noted. Red cell transketolase (for thiamine deficiency), glutathione reductase (for riboflavin deficiency) and aspartate transaminase (for pyridoxine deficiency) were measured. Of the patients, 53 per cent were deficient in at least one vitamin, 12 per cent in more than one (30 per cent in thiamine, 27 per cent in riboflavin and 9 per cent in pyridoxine). Schizophrenics and alcoholics were significantly over-represented in those patients low in thiamine and in more than one vitamin. Patients with an affective disorder had low riboflavin and low pyridoxine. It is suggested that affective changes are characteristic of riboflavin and pyridoxine deficiency.

Phantom limb phenomena during the post-operative period were studied in 72 amputees. All were right handed. Phantom limb was present in 86.1 per cent of the cases, significantly more commonly following amputation of the right arm. Nearly half of the phantoms developed within the first 24 hours and another quarter in the next 24 hours, appearing earlier in lower limb amputees. Movements in the phantom were felt by three-quarters of the cases, an incidence unaffected by site or side of amputation. Telescopy was present in nearly two-thirds and phantom limb pain in over two-thirds, significantly more commonly in the upper limb amputees but uninfluenced by the side of amputation. Thirty-one of the patients dreamed that their limbs were intact.

In a replication study three performance variables measured at the beginning of 200 patients' rehabilitation courses were combined to form an Index to quantify the degree of initial disability. The Index score was significantly associated with the ten-year outcome, and hence has predictive value. With it a level of disability can be specified beyond which a patients' prospect of resettlement is predictably hopeless from the outset despite prolonged and intensive rehabilitative efforts. On the other hand, many less disabled patients cannot achieve resettlement unless such efforts are made. There are, therefore, humanitarian and economic reasons for seeking to distinguish these two groups.

A survey of 1507 mentally handicapped adults in a long-stay hospital, three-quarters of whom were severely subnormal, led to the identification of 42 (2.8 per cent of the total group) with a current typical affective illness. Non-verbal criteria were used so that such conditions could be recognized at any level. Schizophrenia could be diagnosed only on verbally expressed symptoms and was found in 27 (1.8 per cent) of the patients, none of whom was preverbal in mental level. Forty-one (2.7 per cent) had an atypical affective illness superimposed on an early childhood psychosis. Half of these patients were preverbal, so that the pattern of their illness was particularly difficult to recognize.